The Register's Editorial: Lawmaker study is a good beginning

Iowans should not think that our state's emergency medical services can't be improved

If you live in Polk County and dial 911, an ambulance will arrive at your house within about 6 minutes. If you live in Montgomery County, you will wait three times as long. In about half of Iowa counties, the state doesn't even report the average response time for emergency medical services. Perhaps it takes a half hour or more. The public doesn't know.

The person who shows up in the ambulance may be a high school student pulled from class. While physicians and nurses in hospitals spent years receiving a medical education and are overseen by state boards that license and sanction bad actors, the worker who transports you to the hospital and cares for you on the way may have minimal training and might have a long criminal record.

This reality about emergency care in Iowa has been exposed over the past months by Des Moines Register reporter Clark Kauffman. Unlike firefighting services, communities in Iowa are not required to provide any emergency medical services. The state doesn't require background checks of these EMS workers and has never imposed a fine for any ambulance service violation, including those that put patients at risk. Kauffman reported about an EMS technician with 23 convictions and another who tried to kill a teenager he had raped.

There is something wrong when an Iowan experiencing chest pain might be better off calling a neighbor than calling 911 to get to the hospital.

Sen. Mary Jo Wilhelm, D-Cresco, has long recognized this. Even before the Register started reporting on the issue, the former EMS technician shepherded a bill through the Iowa Senate to study access to emergency services. But the bill died in the Iowa House. Then a provision to create the task force and make a small appropriation to pay for it was included in a larger bill that passed both houses of the Iowa Legislature. That was progress - until Gov. Terry Branstad vetoed creation of the task force.

The governor, a former Des Moines medical school president, thought a task force of experts to study and make recommendations related to emergency services was not a good use of government money. He later said he doesn't want to micromanage the Iowa Department of Public Health, which houses a bureau that is responsible for overseeing emergency medical services.

So Wilhelm pushed for the creation of a legislative committee to tackle the issue. The group of 10 lawmakers from both political parties will meet for the first time this week and hear from health professionals, state officials and the public. The goal is to make recommendations to improve access to emergency care. These meetings are the first step toward lawmakers understanding what is going on, Wilhelm said.

Such a discussion is welcome. There are, however, some simple, no-brainer changes lawmakers could approve in Iowa law and state regulations when they convene in January. These include adequately funding the bureau in the public health department that is responsible for certifying EMTs; requiring background checks for these individuals; and requiring public reporting of response times by ambulances in every county.

However, there are other issues lawmakers must address that are not so simple. Iowa is a rural state where there may be too few people interested in volunteering to be EMTs. It may be difficult for some cash-strapped cities to provide services. Elected officials will need to examine how other states provide high-quality emergency care in rural areas. They should also consider whether emergency medical services should be a responsibility of Iowa's hospitals. Rural hospitals may admit few patients on an average day and already employ medical professionals who might be able to staff ambulances heading to the scene of an emergency to help someone in trouble.

Fifty years ago, funeral directors responded to half the calls for ambulances in this country. Hearses were the only vehicles large enough to accommodate stretchers, and it was difficult for someone in a vehicle to communicate with a hospital. The infrastructure of the U.S. health care system has come a long way since then. It's time to bring Iowa's emergency services into the 21st century. Doing so is a matter of life and death for Iowans.

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The Register's Editorial: Lawmaker study is a good beginning

If you live in Polk County and dial 911, an ambulance will arrive at your house within about 6 minutes. If you live in Montgomery County, you will wait three times as long.